Comparison of Clozapine vs Olanzapine in Childhood-Onset Psychotic Disorders

Childhood Onset Psychotic Disorders: Characterization and Treatment With Atypical Neuroleptics

The purpose of this study is to compare the effectiveness and side effects of the drugs clozapine and olanzapine in children and adolescents with schizophrenia and psychoses.

Childhood psychosis is a serious disorder that may have devastating consequences. Effective treatments for the condition are under continual investigation. This study will examine the causes of and offer treatment for childhood psychosis.

Participants in this study will undergo psychological tests, blood and urine tests, electroencephalogram (EEG), electrocardiogram (EKG), and magnetic resonance imaging (MRI) scans of the brain for the first 1 to 2 weeks of the study while taking their regular medications. Participants will then be tapered off their medications over 1 to 3 weeks and will continue to stay off medications for an additional 2 days to 3 weeks. During this time, participants will undergo psychiatric, neurological, and cardiac examinations as well as blood tests. After this period without medications, participants will be randomly assigned to receive either clozapine or olanzapine for 8 weeks. An EEG will be performed prior to treatment and after 6 weeks of study medication. Participants who respond well to the study drugs may continue to receive them through their own physician. Participants who do not respond to either clozapine or olanzapine or cannot tolerate their side effects will be treated individually with other drugs until optimum treatment is identified. Regular telephone updates and in person visits to NIH for repeat testing and MRIs will be conducted.

Study Overview

Detailed Description

The purpose of this protocol is to compare efficacy of clozapine and olanzapine in children and adolescents with schizophrenia and psychoses, as well as to learn about side effects of these medication in pediatric population. The underlying hypothesis is that clozapine has superior efficacy over olanzapine.

Children and adolescents, ages 7 to 18 years, meeting DSM-IV criteria for schizophrenia, schizoaffective disorder and psychotic disorder not otherwise specified, with onset of psychosis before their 13th birthday, who have not responded to at least two prior trials with typical or a typical neuroleptics, will be eligible to participate in a double-blind, parallel group, trial of olanzapine-clozapine.

This study will be done in conjunction with the Screening protocol, which will include characterization by clinical phenomenology, eye tracking, MRI brain imaging, plasma biochemistry, and chromosomal analysis.

This study will consist of the following phases 1) Tapering of psychotropic medications (1-4 weeks, depending upon type and dosage). 2) Observation for up to 2 weeks drug free, in order to establish a baseline prior to starting medication trial. 3) An 8 week double-blind trial of either clozapine or olanzapine. Efficacy and tolerability of clozapine and olanzapine will be compared using specified criteria. 4) If desired improvement not achieved or trial is interrupted, an 8 week open trial of the second medication and 5) Discharge following medication optimization for up to 4 weeks, or as clinically appropriate. This protocol also includes a follow-up every 2 to 3 years for a period of 10 years.

Study Type

Interventional

Enrollment (Actual)

25

Phase

  • Phase 4

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

    • Maryland
      • Bethesda, Maryland, United States, 20892
        • National Institutes of Health Clinical Center, 9000 Rockville Pike

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

7 years to 18 years (Child, Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

  • INCLUSION CRITERIA:

Males and females, age 7 to 18 years

Onset of psychotic symptoms before 13th birthday and a DSM-IV diagnosis of either schizophrenia, schizoaffective disorder, MDI syndrome, or psychosis NOS (not otherwise specified).

Current significant impairment due to the illness (current psychotic symptoms, decline of functioning academically and socially, significant discomfort due to psychotic symptoms).

Failure of two prior trials with antipsychotic medications (either typical or atypical) used at adequate doses (greater than or equal to 100 mg/day in chlorpromazine equivalents) and for adequate duration (at least 4 weeks, unless terminated due to intolerable side effects). Failure is defined as either insufficient response with persistence of symptoms significantly impairing child's functioning, according to child's and parental reports and medical and school records, or intolerable side effects to drugs other than clozapine and olanzapine.

Subjects may be included if their previous trial(s) of olanzapine failed to reach the dose of 20. mg/day or a duration of fewer than four weeks.

Subjects may be included if their previous trial(s) of clozapine failed to reach the dose of 200. mg/day or a duration of fewer than six weeks.

Comorbid psychiatric disorders in the past 12 months are permitted as long as not clinically significant.

EXCLUSION CRITERIA:

Prepsychotic full-scale IQ less than 70.

Unstable major neurological or medical conditions.

Current pregnancy or plan to become pregnant during the first three months (the duration of the study) in woman of childbearing age; breast-feeding in woman with infants.

DSM-IV substance abuse or dependence in the past 6 months.

True non-responders to either olanzapine or clozapine. True non-response is defined as: a) intolerance to either of the medications preventing an adequate trial, or b) only minimal (less than 20%) benefit with the adequate trial of either of the medications. Adequate trial constitutes at least 8 weeks of the medication with the dose of 20 mg on olanzapine or 200 mg of clozapine.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Triple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Olanzapine
tablet; 5-20mg/day; 8 weeks
Other Names:
  • "Zyprexa"
Active Comparator: Clozapine
tablet; 12.5-900mg/day; 8 weeks
Other Names:
  • "Clozaril"

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in the Scale for the Assessment of Negative Symptoms
Time Frame: 8 week double-blind study period; baseline and 8 weeks
Measures change in affective flattening or blunting, alogia, avolition/apathy, anhedonia/asociality, attention; minimum score = 0; maximum score = 125; lower values are considered a better outcome
8 week double-blind study period; baseline and 8 weeks
Change in the Clinical Global Impression Severity of Symptoms Scale
Time Frame: 8 week double-blind study period; baseline and 8 weeks
Measures change in the severity of symptoms; Minimum score = 1; maximum score = 7; lower score is considered a better outcome.
8 week double-blind study period; baseline and 8 weeks
Change in the Brief Psychiatric Rating Scale-24
Time Frame: 8 week double-blind study period; baseline and 8 weeks
A 24-item scale measuring change in interpersonal behaviors, mood, psychosis, anxiety, speech, sleep, orientation and physical activity. Lowest score = 24; highest score = 168; lower score is considered a better outcome.
8 week double-blind study period; baseline and 8 weeks
Change in the Scale for the Assessment of Positive Symptoms
Time Frame: 8 week double-blind study period; baseline and 8 weeks
Measures change in hallucinations, delusions, bizarre behavior, and thought organization. Minimum score = 0; maximum score = 170; lower score is considered a better outcome.
8 week double-blind study period; baseline and 8 weeks
Change in the Bunney-Hamburg Rating Scale for Psychosis
Time Frame: 8 week double-blind study period; baseline and 8 weeks
Measures change in psychosis severity; Minimum score = 0; maximum score = 7; lower score is considered a better outcome.
8 week double-blind study period; baseline and 8 weeks
Change in Bunney-Hamburg Rating Scale for Depression
Time Frame: 8 week double-blind study period; baseline and 8 weeks
Measures change in severity of depression; Minimum score = 0; maximum score = 7; lower score is considered a better outcome.
8 week double-blind study period; baseline and 8 weeks
Change in Bunney-Hamburg Rating Scale for Mania
Time Frame: 8 week double-blind study period; baseline and 8 weeks
Measures change in the severity of mania; Minimum score = 0; maximum score = 7; lower score is considered a better outcome.
8 week double-blind study period; baseline and 8 weeks
Change in the Bunney-Hamburg Rating Scale for Anxiety
Time Frame: 8 week double-blind study period; baseline and 8 weeks
Measures change in the severity of anxiety; Minimum score = 0; maximum score = 7; lower score is considered a better outcome.
8 week double-blind study period; baseline and 8 weeks

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Weight
Time Frame: 8 week double-blind study period; baseline and 8 weeks
8 week double-blind study period; baseline and 8 weeks
Change in Body Mass Index (BMI)
Time Frame: 8 week double-blind study period; baseline and 8 weeks
BMI is calculated by the following formula: weight (in kilograms) divided by the square of the height (in meters)
8 week double-blind study period; baseline and 8 weeks
Change in Extrapyramidal Movements as Measured by the Abnormal Involuntary Movements Scale (AIMS)
Time Frame: 8 week double-blind study period; baseline and 8 weeks
minimum score = 10; maximum score = 50; lower score is considered a more favorable outcome
8 week double-blind study period; baseline and 8 weeks
Change in Extrapyramidal Movements as Measured by the Simpson Angus Scale Score
Time Frame: 8 week double-blind study period; baseline and 8 weeks
minimum score = 10; maximum score = 90; lower score considered a more favorable outcome
8 week double-blind study period; baseline and 8 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

  • Principal Investigator: Judith L Rapoport, M.D., Child Psychiatry Branch, NIMH, NIH

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

June 1, 1997

Primary Completion (Actual)

June 1, 2008

Study Completion (Actual)

June 1, 2008

Study Registration Dates

First Submitted

November 3, 1999

First Submitted That Met QC Criteria

November 3, 1999

First Posted (Estimate)

November 4, 1999

Study Record Updates

Last Update Posted (Estimate)

April 12, 2011

Last Update Submitted That Met QC Criteria

March 11, 2011

Last Verified

March 1, 2011

More Information

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Clinical Trials on Schizophrenia

Clinical Trials on Olanzapine

Subscribe